Assessment of health‐related behaviors among medical students: A cross‐sectional study

Abstract Background and Aim Students sometimes participate in harmful activities that adversely influence their behaviors and well‐being throughout college, which is one of the sensitive phases in an individual's life. Aim: To assess the health‐related behaviors of university students. Methods A cross‐sectional study that includes systematic randomly selected 383 students from various colleges of Ras Al Khaimah Medical and Health Sciences University (RAKMHSU), Ras Al Khaimah Emirate, United Arab Emirates. A self‐reported questionnaire included students' demographic traits and behaviors, including safety, medication intake, cigarette smoking, nutrition, physical activity, and health‐related topics. Results Most participants were females (69.7%), 13.3% were obese while 28.2% were overweight. The data revealed a significant difference between male and female students regarding medication intake without prescription, nutrition, physical activity, and health‐related topics. The data also revealed that the majority of the students were attempting to lose weight, and the former male smokers had fewer trials to quit the use of all tobacco products than females. Conclusion More than a quarter of participants were overweight, and the majority of students did not adhere to the guidelines for safety and nutritious eating. This study recognized significant health promotion opportunities for university students that can be carried out to establish a healthier youth for society.


| INTRODUCTION
A changeover from secondary school to university education is a critical period in student's life. The students are more likely to participate in unhealthy practices that could have a long-term negative impact on their health, such as lack of exercise, and poor eating habits. One of the most crucial determinants influencing the maintenance and improvement of health is health-related behaviors and lifestyle. 1,2 University life is full of challenges for young adults. It becomes more demanding as they face various cognitive and emotional changes grounded in biological, psychological, social, and economic forms. Young people confront several demands when they enroll in college that include staying away from home, adjustment to a new multiethnic and multicultural environment, new food types and patterns, independent living, finding new friends, and still trying to be self-reliant, coping with higher-level studies, and academic stresses. 3 Additionally, young people frequently exhibit curiosity and exploration, exposing them to various health risks. 4 On the other hand, colleges and universities may play a significant role in lowering the prevalence of overweight in the adult population through the promotion of good nutrition and exercise guidelines to apply for the healthy weight management program. So, many college students may experience changes in the pattern of their lifestyle during their college years. 5 The healthy lifestyle of young adults, which may establish during college, significantly influences their health and, also, their prospective families. Additionally, an unhealthy lifestyle of college students may lead to unfavorable physiological consequences in their future. So, college students are in a life stage and situation where it is easier for them to change their behavior. 6 Few largescale studies conducted at the university levels in numerous low-, middle-, and high-income nations have discovered that there were relatively few people practicing healthy eating habits, 7 presence of depressive symptoms, 8 physical inactivity, 9 involvement in gambling and high rate of overweight or obesity among students at the college. 10 In the United Arab Emirates (UAE), an Arab nation with a high standard of living, noncommunicable diseases (NCDs) are to blame for 77% of fatalities. 11 Rahim et al. 12 reported that in the Arab world, including the UAE, there is an increase in the prevalence of NCDs, diabetes, cancer, chronic lung illnesses, and cardiovascular disease. Indicators of behavioral NCD health risk are particularly prevalent among Arab children and adults.
Hence, this study aimed to assess medical university students' health behavior in relation to safety, smoking, nutritional habits, and physical activities to know what may affect their health.
Research results may be beneficial for planning and organizing university health promotion activities to improve the health status of young adults who represent a significant community investment. Students who reported the presence of a physical illness (e.g., heart disease or bronchial asthma) at the time and those who declined to take part in the study were not included.

| Sampling technique and sample size calculation
The students were chosen using a systematic random sampling approach within each different academic year in all the four colleges.
The sample size was determined by taking the frequency of unhealthy behaviors among the students as 47% to the estimated proportion of students. 13 The significance level (p = 0.05) and intent of error was 5% (deviation from the actual value).
With a 47% proportion at a 95% confidence interval, the estimated sample size calculated was 383. A total of 383 students were finally surveyed.

| Data collections and tools
A lifestyle questionnaire was adapted from National Youth Risk Behavior Survey, 2017. 14 It included two parts, Part 1: questions about students' demographic characteristics which included age, gender, nationality, college, academic year, previous year's academic performance, family history of lifestyle diseases, weight, and height. Part 2: assessment of student health-related behavior; safety, medication intake, cigarette smoking, food consumption, physical activity, body weight perception, and health-related topics. Necessary modifications were made to make it

| Pilot study
Thirty students participated in the pilot study (not included in the study) to test the questionnaire to ensure its suitability for data collection. Minor adjustments to the questionnaire were modified.

| Measurements
The digital electronic Seca 284 were used to measure the body's weight and height, respectively. Body mass index (BMI), which measures a person's weight in kilograms in relation to their height in square meters, was used to determine their current weight  On their acceptance, they were asked to sign the consent form.

| Ethical considerations
They were assured of the anonymity and confidentiality of the collected information. The participants had the right to discontinue their participation at any moment and without providing a reason. The data was only collected, entered, and analyzed under strict confidentiality, and it was solely intended for scientific purposes.

| RESULTS
Out of the 400 students who were invited to participate in the study, 7 out of 400 were excluded due to missing data, 10 out of 400 refused to participate. Finally, 383 students successfully completed the questionnaire, resulting in an impressive response rate of 95.7% ( Figure 1). Their ages ranged from 17 to 36 years, with a mean and standard deviation of 22.7 (6.4). The majority of the students were females (69.7%). According to their BMI interpretation, 55.1% of the students had normal weight, 28.2% were overweight, and 13.3% were obese. Less than half (41.8%) of the students were enrolled in medical college, and most of the students were either in their first or second-year class (59%). Around half (47.5%) of the students were Arab. Almost all of the participants (98%) had a family history of chronic disease as diabetes (50.9%), hypertension (40.7%), cardiac diseases (19.3%), cancer (17%), and COPD (4.2%). More than onefifth (27.2%) of the students reported having families with smoking status, and 40.7% of the students stated their academic grades as mostly B (Table 1).
The differences in health practice among male and female students are displayed in Table 2. The study findings highlight that very few students, both females (15%) and males (12.1%), sometimes wore seat belts when riding in a car driven by someone else with no significant difference among males and females (p = 0.30). Concerning medication intake, 48.1% of females compared with 65.5% of male students use of prescription painkillers without a doctor's prescription or otherwise outside of what a doctor advised differed significantly between male and female students (p = 0.000).
There were significant disparities between males and females in their daily consumption of fruits, green salad, breakfast, milk, and an adequate amount of water per day (p = 0.000, 0.032, 0.042, and 0.000, respectively). Less than half (45.3%) of female students always drank a can, bottle, or glass of soda and sports drink per day opposed to 43.1% of male students, with no significant difference (p = 0.194) among them. The majority of male and female students (86.2%) (87.6%) ate food high in fat and cholesterol, with no significant difference (p = 0.289) among both genders.
In terms of physical activity, 46.1% of female compared with 21.5% of male students always perform pushups, sit-ups, or weightlifting activities with a statistically significant difference (p = 0.005). But when it came to participating in sports teams and being physically active for at least 60 min/day, 39.3% of females compared with 36.2% of male students sometimes do it with no discernible difference between male and female students (p = 0.240, 0.133, respectively). Less than one-third (32.6%) of female students and 31.8% of male students sometimes watched TV during their university days, with significant differences (p = 0.005).
Analyzing the health-related topics, 50.6% of females compared with 41.4% male students visiting a dentist for a check-up with a statistically significant differences were identified between males and females (p = 0.000). In relation to sleeping adequate time per day, 30.3% of female and 46.5% of male students always have adequate sleep with a statistically significant difference (p = 0.010). However, EL-KADER ET AL. | 3 of 9 71.9% of female and 75.9% of male students never use of an antisunburn product with no discernible difference between male and female students (p = 0.204) ( Table 2). Table 3 illustrates the experimentation of the students with tobacco products, 16.5% of females compared with 44.0% of male students had undergone a trial of cigarette smoking with a statistically significant difference (p = 0.000). Notably, the average age of first-time testing for all forms of tobacco was 14-15 years among females compared with 11-12 years of age among males with a statistically significant difference (p = 0.008). On average, in the last 30 days, the female students smoked cigarettes for 10 days, whereas the males smoked for all 30 days with a statistically significant difference (p = 0.001). Furthermore, the average number of days students used chewing tobacco, snuff, dip, or dissolvable tobacco products and smoked cigars, cigarillos, or small cigars was 1 day among female students during the course of the last 30 days, whereas it was 2 days among males with a statistically significant difference (p = 0.000). Male students smoke more cigarettes than females per day with no statistically significant difference (p = 0.082).
Half (50%) of female and 33.3% of male students had undertaken a trial to quit the consumption of tobacco products with no statistically significant difference (p = 0.052). Table 4 describes the students' perception of their weight. The majority of the students (76.2%) expressed that they had the right weight or were slightly overweight. In spite of this, 58.7% of the students wanted to lose weight, whereas only 12.8% stated that they were very overweight, while another 11.7% they did not want to make any efforts to lose weight.

| DISCUSSION
A healthy lifestyle is the cornerstone of the overall health of the people, and healthy people determine the health of the nation.
Today's youth are the greatest strength of the nation. Future health of university students might be affected by their current dietary habits, exercise habits, and lifestyle choices. The current study highlights the health-related behaviors among medical university students in RAK Emirate, UAE. The findings showed that male and female students' medicine intake varied significantly. It was identified that about half of the students were using prescribed painkillers either differently than a doctor had advised or without a doctor's prescription. This is consistent with research by Alduraibi and Altowayan 16 in Saudi Arabia, who reported that the majority of F I G U R E 1 STROBE flowchart. students (88%) chose painkillers as their primary form of selfmedication, accounting for more than half (64%) of students who engaged in this activity in the past 6 months. Moreover, Alshahrani et al. 17 in Saudi Arabia, and Alshogran et al. 18 in Jordan, reported that for a variety of symptoms, the majority of the student's used selfmedication.
It is a well-known fact that adventures and risk-taking are the features of youngsters which may sometimes be damaging to their health. This study reported that most of the students never used a seatbelt while riding in a vehicle that was being driven by someone else. The university students are relatively young and do not consider the importance of fastening the seat belts while riding in a car for their safety. 19 Similar findings were reported by Fildes et al. 20 that the likelihood of seatbelt use among teenagers and young adults is lower.
Physical activity is one of the most crucial factors affecting health. The results showed a substantial difference between males and females in terms of the degree of physical activity among students; more female students engaging in regular muscle-building exercises than male students. This finding may be attributable to the students' improved health awareness, which is seen in a positive relationship between their exercise activity and it. More so, constant motivation is required to perform regular physical activities, especially to maintain body weight and health. Similar findings were reported by various studies carried out among college students.
Almutairi et al. 2 stated that there were significant differences across response waves of doing stretching exercises at least three times per week among the students in nonhealth and health-specific colleges.
However, male and female students responded to being physically active for at least 60 min each day in the same way, with no discernible differences. Klainin-Yobas et al. 21 reported that nursing students' overall physical fitness levels ranged from poor to moderate in Thailand, with the lowest scores for the components of body flexibility and cardiovascular fitness. Almutairi et al. 2 and Park et al. 22 in Korea, stated that the students deny and do not engage in light to moderate physical activity.
With regard to nutrition and food habits, there was a significant difference in daily intake of nutritious food between male and female students. Consumption of fruits and green salad on a regular basis was reported by only one-fourth and less than one-fourth of the male and female students, respectively, whereas a substantial number of male and female students said they eat fruits and green salad only sometimes. This is in agreement with the results of previous studies, who reported that most students have a low intake of fruits and vegetables. 2,[23][24][25] In contrast to these findings, Sakamaki et al.
(2005) 26 reported higher consumption of fruits and vegetables among university students in China. The present study has shown that much less than 50% (44% females and 39% males) of the students were eating breakfast, which is in contrast with the result of a study by Al-Rethaiaa et al. 26 and Almutairi et al. 2,27 who reported that the immense majority of students eat breakfast. 2,19 The results T A B L E 1 Demographic data of the students (n = 383).

Demographics
Frequency % Be physically active for at least 60 min each day.
c Performing muscle-strengthening or muscle-toning exercises, such as pushups, sit-ups, or weightlifting.
of this study exhibited a significant difference between male and female students in relation to drinking milk and adequate amounts of water. This is in line with Almutairi et al. 2 reported that more than half of the students had two to three servings of milk, yogurt, or cheese each day.
In the current study, most of the students ate foods that were rich in fat and cholesterol. This result is in agreement with other studies concluded that majority of the students did not select diets This is in consensus with a study by Chinwong et al., 31 in Thailand, who concluded that male and female university students differed in smoking behaviors and intention to quit. 31 Male students had higher smoking behavior, and they were more likely to smoke every day with a high average number of cigarettes daily, and the females were more likely than males to express intention to quit in the next 30 days.
Hafez et al. in Egypt also reported that the smoking prevalence is significantly higher among male university students. 32 Maintaining body weight is an important aspect of healthy living.
The present study has highlighted that about half of the students were attempting to lose weight, compared with one-third of students who identified as overweight or obese. This is in accordance with a study by Asfour et al. 33  Universities are perfect locations/platforms for applying for goal-oriented health promotion programs, planning and conducting those programs to motivate students to be more responsible for their own health as well as practice healthy behaviors with the aim of preventing diseases and promoting health are of paramount significance.
Additionally, universities must develop curricula and counseling programs with the goal of providing students the information, encouragement, and empowerment required to make wise decisions about their health.

| Limitation
The university students who provided the data may have provided responses that they believed the researchers wanted to hear because the data gathering method relied on self-reporting. Furthermore, because only one university and only health science students was included in the survey, the findings cannot be applied to university students in the entire UAE.

| CONCLUSION
In conclusion, more than one-quarter of the participants in the present study were overweight, and most of the students were less adherent to recommendations regarding to the use of safety belt and text or e-mail while operating a car. There was a significant difference between male and female students regarding medication intake without prescription. The analysis showed a significant difference between male and female students regarding the elements of nutrition, physical activity, and health-related topics. The majority of the students, according to the data, were trying to slim down, and former smokers of tobacco products who were males had less success quitting than those who were females.